I.M. injections: Pick your site

Two stories about cesarean deliveries or C-sections, which are increasingly prevalent in the United States, recently made the news. • Nurses employed by Hospital Corporation of America (HCA) have been authorized to begin preparations for emergency cesarean deliveries without a physician’s order. By giving nurses this responsibility, the hospital system aims to keep the time between admission and start of procedure to 30 minutes or less, which would meet current practice standards and reduce the hospital’s malpractice liability risk. An HCA study found that many procedures fail to meet the 30-minute standard because of an inability to get the team together quickly and an inconsistent definition of “emergency.” By allowing nurses to initiate preparations, HCA has reduced the number of procedures that begin after the 30-minute deadline by nearly two-thirds. • An independent panel formed by the National Institutes of Health couldn’t find sufficient evidence to recommend for or against cesarean deliveries performed at the mother’s request without any medical indication for the procedure. But the panel did recommend that women who request a cesarean delivery receive counseling about the benefits and drawbacks. The panel also recommended against elective cesarean deliveries for women who want large families (because risks in subsequent pregnancies increase with each cesarean delivery) and against cesarean delivery before the 39th week of pregnancy or without verification that the baby’s lungs have matured. Full text of the panel’s findings is available at http:// consensus.nih.gov. Nursing2006 Volume 36, Number 6

Two stories about cesarean deliveries or C-sections, which are increasingly prevalent in the United States, recently made the news.
• Nurses employed by Hospital Corporation of America (HCA) have been authorized to begin preparations for emergency cesarean deliveries without a physician's order. By giving nurses this responsibility, the hospital system aims to keep the time between admission and start of procedure to 30 minutes or less, which would meet current practice standards and reduce the hospital's malpractice liability risk.
An HCA study found that many procedures fail to meet the 30-minute standard because of an inability to get the team together quickly and an inconsistent definition of "emergency." By allowing nurses to initi-ate preparations, HCA has reduced the number of procedures that begin after the 30-minute deadline by nearly two-thirds.
• An independent panel formed by the National Institutes of Health couldn't find sufficient evidence to recommend for or against cesarean deliveries performed at the mother's request without any medical indication for the procedure. But the panel did recommend that women who request a cesarean delivery receive counseling about the benefits and drawbacks. The panel also recommended against elective cesarean deliveries for women who want large families (because risks in subsequent pregnancies increase with each cesarean delivery) and against cesarean delivery before the 39th week of pregnancy or without verification that the baby's lungs have matured. Full text of the panel's findings is available at http:// consensus.nih.gov.

Washington gives nurses' backs a break
Nurses in Washington State are celebrating passage of a bill that promotes safe patient handling and aims to protect nurses and other health care workers from back injuries. The legislation establishes a Safe Patient Handling Committee (at least half of committee members must be direct care providers) and implements a safe patient-handling policy to prevent musculoskeletal injuries. Hospitals are mandated to acquire lifting equipment and provide staff-development sessions about lifting techniques.
Last summer, Texas became the first state to pass safe patient-lifting legislation.

Sputum test detects cancer earlier
A promising experimental test of genetic material in sputum may soon let clinicians detect and treat lung cancer at an earlier, more curable stage. In studies, the test identified 65% of people who developed lung cancer up to 18 months later, but it also yielded false-positive results 35% of the time.
Researchers have identified six genes that can predict lung cancer development. Among people in whom three or more of these six genes were inactivated, the risk of developing lung cancer increased more than sixfold.
Currently, just 15% of patients with lung cancer survive 5 years beyond diagnosis because the disease is typically diagnosed at an advanced stage.
Source: Promoter hypermethylation of multiple genes in sputum precedes lung cancer incidence in a high-risk cohort, Cancer

Patients pour in with the rain
According to a study, daily precipitation and high temperatures are valid predictors of trauma admission volume. Researchers analyzed data on about 8,300 trauma patients admitted to a Louisville, Ky., level-one trauma center from July 1996 to January 2002, and correlated their findings with corresponding local weather data. They reported these findings: • 5.25% increase in hourly incidents for each 10-degree difference in temperature • a 60% to 78% increase for each inch of precipitation in the previous 3 hours.
In press reports, the study authors said they were surprised to learn that wintry weather didn't seem to cause a surge of trauma-related admissions. They speculated that in Louisville, people tend to stay home when winter weather turns bad. The research was reported at the annual meeting of the American Academy of Orthopaedic Surgeons in Chicago, Ill.

Birth weight linked to child abuse
Infants who are premature and underweight appear to be at particular risk for abuse, including sexual abuse, British researchers report. They looked at records on 119,771 infants born between 1983 and 2001 for whom certain information was available (maternal age, birth weight, and gestational age at delivery). They compared this information with data from a register that included children who were physically, emotionally, or sexually abused or neglected and were believed to be at risk for more abuse.
For all categories of abuse, they found a correlation between rates of registration and low levels of fetal growth. Similarly, they found a correlation between registration and shorter gestational duration (prematurity). These findings held true regardless of socioeconomic status or maternal age.
Researchers can't explain their findings, but speculate that premature infants may have characteristics that are more likely to provoke hostility in caregivers.
Source: Child abuse registration, fetal growth, and preterm birth: A population based study, Journal of Epidemiology and Community Health, N Spencer, et al., April 2006. CABG SURGERY

Women at higher risk for infection
Why are mortality rates following coronary artery bypass graft (CABG) surgery higher for women than men? Higher infection rates among women may help explain the discrepancy.
Researchers analyzed clinical outcomes of 9,218 patients age 65 and older who had CABG surgery. Mortality rates in the 100 days after surgery were 9.2% for women and 6.4% for men.
Sixteen percent of the women had an infection during their hospital stay, compared with just under 10% of men. Common infection sites included the urinary, respiratory, and gastrointestinal systems, and the skin and subcutaneous tissue. The higher infection rates for women held true regardless of such factors as age, race, and concurrent conditions.
Being female carried a 13.9% mortality risk. But after researchers adjusted the data for infection, the mortality risk for women decreased to 0.3%.
Researchers can't say what accounts for higher infection rates among women. Possibilities in-clude differences in glucose control in those with diabetes and a higher prevalence of immunerelated disorders, leading to greater use of immunosuppressive drugs. Genetic differences in immune and inflammatory responses may also contribute to different infection rates between the sexes.
Researchers stress the importance of strictly adhering to infection control guidelines. These include administering prophylactic antibiotics within 1 hour before making a surgical incision and vaccinating health care workers and patients against Using an algorithm from the Framingham Heart Study, the researchers estimated the risk of developing coronary heart disease over the course of 10 years. They found that if patients achieved optimal control for hypertension, high LDL (bad) cholesterol, and low HDL (good) cholesterol, the number of adverse heart events in the United States would drop by 75%. The researchers, statisticians with Pfizer, Inc., presented their findings at the 55th Annual Scientific Session of the American College of Cardiology.